This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (24)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Gastrointestinal Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

An Alternative Therapeutic Plan

Arthur J. Donovan, MD; Thomas V. Berne, MD; John A. Donovan, MD

Arch Surg. 1998;133:1166-1171.

An alternative plan for the treatment of a perforated duodenal ulcer is proposed. We will focus on the now-recognized role of Helicobacter pylori in the genesis of the majority of duodenal ulcers and on the high rate of success of therapy with a combination of antibiotics and a proton-pump inhibitor or histamine₂ blocker in treatment of such ulcers. Knowledge that half the cases of perforated duodenal ulcer may have securely sealed spontaneously at the time of presentation is incorporated in the therapeutic plan. Patients with a perforated duodenal ulcer who have already been evaluated for H pylori and are not infected or, if infected, have received appropriate therapy should undergo an ulcer-definitive operation if they are suitable surgical candidates. Most authorities recommend surgical closure of the perforation and a parietal cell vagotomy. The remaining patients should have a gastroduodenogram with water-soluble contrast medium. If the perforation is sealed, the patient can be treated nonsurgically. If the perforation is leaking, secure surgical closure of the perforation is necessary. Following recovery from the immediate consequences of the perforation, evaluation for H pylori should be conducted. If the patient is infected, combined medical therapy is recommended. If the patient is not infected, Zollinger-Ellison syndrome should be ruled out and medical therapy is recommended if the ulcer has not been treated previously. Elective ulcer-definitive surgery should be considered for the occasional uninfected patient who has already received appropriate medical therapy for the ulcer.

From the Department of Surgery, University of Southern California, Los Angeles (Drs A. J. Donovan and Berne); and the Division of Gastroenterology, Southern California Permanente Medical Group, Los Angeles (Dr J. A. Donovan).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

An example of the healing powers of a human being
Bosanko et al.
BMJ Case Reports 2009;2009:bcr0620080143-bcr0620080143.
ABSTRACT | FULL TEXT  

Laparoscopic Repair of Perforated Duodenal Ulcers: Outcome and Efficacy in 30 Consecutive Patients
Katkhouda et al.
Arch Surg 1999;134:845-850.
ABSTRACT | FULL TEXT